Pediatric Traumatology, Orthopaedics and Reconstructive SurgeryPediatric Traumatology, Orthopaedics and Reconstructive Surgery2309-39942410-8731Eco-Vector11523010.17816/PTORS115230Review ArticleTreatment of long bone defects in children: Microsurgical transplantation of a fibular fragment for replacement of long bone defects: A systematic reviewZakharyanEkaterina A.<p>MD, PhD, Cand. Sci. (Med.)</p>zax-2008@mail.ruhttps://orcid.org/0000-0001-6544-1657DolgievBagauddin H.<p>MD, Orthopedic and Trauma Surgeon</p>dr-b@bk.ruhttps://orcid.org/0000-0003-2184-5304ChigvariyaNikolay G.<p>MD, PhD, Cand. Sci. (Med.)</p>chigvariya72@mail.ruhttps://orcid.org/0000-0003-4842-7639GrankinDenis Yu.<p>MD, Research Associate</p>grankin.md@gmail.comhttps://orcid.org/0000-0001-8948-9225AfonichevKonstantin A.<p>MD, PhD, Dr. Sci. (Med.)</p>afonichev@list.ruhttps://orcid.org/0000-0002-6460-2567GarkavenkoYuriy E.<p>MD, PhD, Dr. Sci. (Med.)</p>yurijgarkavenko@mail.ruhttps://orcid.org/0000-0001-9661-8718ArakelyanAnastasia I.<p>MD, PhD, Cand. Sci. (Med.)</p>a_bryanskaya@mail.ruhttps://orcid.org/0000-0002-3998-4954PozdeevAleksandr P.<p>MD, PhD, Dr. Sci. (Med.), Professor</p>prof.pozdeev@mail.ruhttps://orcid.org/0000-0001-5665-6111H. Turner National Medical Research Center for Children’s Orthopedics and Trauma SurgeryNorth-Western State Medical University named after I.I. Mechnikov08042023111951040812202215032023Copyright © 2023,2023<p><strong><em>BACKGROUND</em></strong><em>:</em> The use of a vascularized fibular graft during reconstructive interventions on the limbs in children is a promising direction in the replacement of extensive bone defects in children.</p>
<p><strong><em>AIM</em></strong><em>:</em> This study aimed to conduct a systematic review of the literature on microsurgical transplantation of a fragment of the fibula in the replacement of long bone defects in children.</p>
<p><strong><em>MATERIALS AND METHODS</em></strong><em>:</em> Articles were searched in systems such as eLibrary, PubMed, and Google Scholar, with a search time range of 10 years (from 20122022, last query 11/08/2022). The following keywords were used for searching in Russian-language search engines: replacement of bone defects in children and fibula transplantation in children, and in the English-language search engines, microsurgical and fibula, microvascular and fibula, and bone and defect were used. After sorting the published studies, 17 publications were analyzed.</p>
<p><strong><em>RESULTS</em></strong><em>:</em> The study analyzed a total of 690 patients (mean age 12 2.6 years). The predominant cause of the defects was malignant tumors in 647 patients (93.7% of all patients). Benign processes were also noted, which accounted for 0.87% of all patients: osteomyelitis, 2.0%; congenital pathology, 2.17%, and trauma, 1.45%. The mean follow-up period was 4.8 2.4 years. The survival rate of patients with cancer was 78.4%. Donor-side complications accounted for 14.7% of all complications. Recipient-zone complications were frequent and accounted for 85.3% of all complications (<em>n</em> = 457 cases). The main type of complications reported in the studies was graft fracture or fracture at the graft-bone level (35.7% of all complications).</p>
<p><strong><em>CONCLUSIONS</em></strong><em>:</em> The use of a fragment of the vascularized fibula in the replacement of extensive bone defects enables a one-stage reconstruction of the limb with good long-term results in large segmental defects of various features. Despite the complications, this technique is one of the few that enables simultaneous limb reconstruction. The decision to use microsurgical fibula autotransplantation is based on the preference and surgical experience of the surgeon.</p>microsurgerybone tumorsreconstructive interventionsfibulaamputationмикрохирургияопухоли костейреконструктивные вмешательствамалоберцовая костьампутация显微外科骨肿瘤重建干预措施腓骨截肢[Weichman KE, Dec W, Morris CD, et al. Lower extremity osseous oncologicreconstruction with composite microsurgical free fibula inside massive bony allograft. Plast Reconstruct Surg. 2015;136(2):396–403. DOI: 10.1097/PRS.0000000000001463][Soldado F, Fontecha CG, Barber I, et al. Vascularized fibular periosteal graft: a new technique to enhance bone union in children. J Pediatr Orthop. 2012;32(3):308–313. DOI: 10.1097/BPO.0b013e31824b2843][Soldado F, Diaz-Gallardo P, Sena-Cabo L, et al. Vascularized fibular grafts extended with vascularized periosteum in children. Microsurgery. 2017;37(5):410–415. DOI: 10.1002/micr.30063][Repo JP, Sommarhem A, Roine RP, et al. Free vascularized fibular graft is reliable in upper extremity long-bone reconstruction with good long-term outcomes. J Reconstr Microsurg. 2016;32(7):513–519. DOI: 10.1055/s-0036-1581075][Barla M, Polirsztok E, Peltié E, et al. Free vascularised fibular flap harvesting in children: an analysis of donor-site morbidity. Orthop Traumatol Surg Res. 2017;103(7):1109–1113. DOI: 10.1016/j.otsr.2017.05.009][Erol B, Basci O, Topkar MO, et al. Mid-term radiological and functional results of biological reconstructions of extremity-located bone sarcomas in children and young adults. J Pediatr Orthop B. 2015;24(5):469–478. DOI: 10.1097/BPB.0000000000000189][Karami RA, Ghieh FM, Saghieh SS, et al. The use of the fibula flap in post oncologic reconstruction of long bone in pediatric patients: a retrospective cohort study. J Plast Reconstr Aesthet Surg. 2021;8(21). DOI: 10.1016/j.bjps.2021.03.017][Adam D, Hamel A, Perrot P, et al. Long-term behavior of the vascularized fibular free flap for reconstruction of bony defects in children. Ann Chir Plast Esthet. 2020;65(3):219–227. DOI: 10.1016/j.anplas.2019.07.004][McCullough MC, Arkader A, Ariani R, et al. Surgical outcomes, complications, and long-term functionality for free vascularized fibula grafts in the pediatric population: a 17-year experience and systematic review of the literature. J Reconstruct Microsurg. 2020;36(5):386–396. DOI: 10.1055/s-0040-1702147][Rabitsch K, Maurer-Ertl W, Pirker-Frühauf U, et al. Intercalary reconstructions with vascularised fibula and allograft after tumour resection in the lower limb. Sarcoma. 2013;2013. DOI: 10.1155/2013/160295][Ruiz-Moya A, Lagares-Borrego A, Sicilia-Castro D, et al. Pediatric extremity bone sarcoma reconstruction with the vascularized fibula flap: observational study assessing long-term functional outcomes, complications, and survival. J Plast Reconstr Aesthet Surg. 2019;72(12):1887–1899. DOI: 10.1016/j.bjps.2019.08.009][Errani C, Ceruso M, Donati DM, et al. Microsurgical reconstruction with vascularized fibula and massive bone allograft for bone tumors. Eur J Orthop Surg Traumatol. 2019;(29):307–311. DOI: 10.1007/s00590-018-2360-2][Sainsbury DCG, Liu EH, Alvarez-Veronesi MC, et al. Long-term outcomes following lower extremity sarcoma resection and reconstruction with vascularized fibula flaps in children. Plast Reconstruct Surg. 2014;134(4):808–820. DOI: 10.1097/PRS.0000000000000555][Schwarz GS, Disa JJ, Mehrara BJ, et al. Reconstruction of oncologic tibial defects in children using vascularized fibula flaps. Plast Reconstruct Surg. 2012;129(1):195–206. DOI: 10.1097/PRS.0b013e318230e463][Ghoneimy AM, Sherbiny ME, Kamal N. Use of vascularized fibular free flap in the reconstruction of the femur in pediatric and adolescent bone sarcomas: complications and functional outcome. J Reconst Microsurg. 2019;35(2):156–162. DOI: 10.1055/s-0038-1668142][Houben RH, Rots M, Heuvel SCM, et al. Combined massive allograft and intramedullary vascularized fibula as the primary reconstruction method for segmental bone loss in the lower extremity: a systematic review and meta-analysis. JBJS Rev. 2019;7(8). DOI: 10.2106/JBJS.RVW.18.00166][Matthew T, Houdek MD, Eric R, et al. What is the outcome of allograft and intramedullary free fibula (capanna technique) in pediatric and adolescent patients with bone tumors? Clin Orthop Relat Res. 2016;474(3):660–668. DOI 10.1007/s11999-015-4204-2]